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been increased to 3.5 S.R.N.s and 4.5 auxiliaries. The service has aroused much interest and several
visits have been made to the Borough by nursing officers anxious to start night nursing services
in their own authorities.
The Health Visiting Service
The staff situation in this service is improving and at the end of the year was considerably
better than at the end of 1971. Nine students sponsored by the Borough qualified in September,
and in addition there was increased recruitment of qualified health visitors to the service.
A work study undertaken during the year demonstrated the need for more clinic nurses, clinic
clerks and nursing auxiliaries in this service. A programme of phased implementation of these proposals
will start in 1973.
Health visitors' uniform was also changed during the year. They are now able to wear any style
of suit (including trouser suits) providing the colour is of royal or darker blue, and may wear any
colour blouse. The ability to wear a trouser suit has been much appreciated, particularly by the younger
members of staff.
At two clinics pilot schemes have been established whereby mothers bringing their toddlers
to the clinic can attend a "mothers' club" where health education topics are discussed and a planned
programme of discussion subjects is prepared.
A considerable part of the health visitor's work is health education, both formal and informal,
and full details of this will be found in the Health Education Section of this report.
Attachment and Liaison Schemes
With the gradual increase in overall staffing of the Community Nursing Service it has been
possible to start new attachment and liaison schemes. At the end of the year four practices of general
practitioners had full attachment of nurse, midwife and health visitor, and twenty-two practices
had part attachment, i.e. attachment of one member of the nursing team only.
In one attachment scheme it has been possible to arrange for the nursing staff to visit patients
of the practice who live outside the geographical boundary of the Borough. This has already proved
very successful and it is hoped that further such arrangements may be possible in other parts of the
Borough.
Where attachment is not yet possible liaison schemes are being established between groups
of general practitioners and community nursing staff. In these schemes the nurse continues to work
in a geographical area but establishes and maintains a close contact with the general practitioners.
Domiciliary Midwifery Service
The expected trend in domiciliary midwifery continues, reflecting the trend in the rest of the
country. The number of mothers who were discharged home early after hospital confinement rose
to 711 as against 313 in 1971, of these 126 were discharged before the fifth post-natal day. In order
to deal effectively with this increased load on the service four part-time midwives were appointed
whose main task is to care for the "early discharge" mothers.
A total of 629 mothers were delivered by the domiciliary midwives, of whom 136 had their
babies in the unit at the Duchess of Kent Maternity Wing. This is an increase of unit deliveries from
98 in 1971.
Packs for midwifery deliveries have been available as a pilot scheme from the central supply
department at Hillingdon Hospital for about one third of all cases, and this, it is hoped, will extend
to fully cover the service in 1973. Recruitment of suitably qualified midwives is difficult and the
service has consistently been below the desirable staffing levels.
Concern is felt about the high numbers of mothers in the "At Risk" categories who continue to
book for home confinement, and every effort is made to encourage them to go into hospital for
delivery.
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